Community Care Services for Older People in Taiwan

University of Bath

Social and Policy Sciences Dept.

Ph.D student

Ju-Huey Wen

Location Eastern Asia Islands bordering the East China Sea,

Philippine Sea, South China Sea, and

Taiwan Strait

North of the Philippines

Off the southeastern coast of Mainland

China

GNP US $ 12,876 (2002)

Population nearly 23 million

Economic structure1950 Agricultural exports

1960s & 70s Light manufacturing

1980s & 90s High technology and

chemical product exports

1995~ Technology-intensive products

TaiwanTaiwan

1624 Dutch & Spanish colonized Taiwan

1662 Jheng Cheng-gong defeats Dutch forces, ending Dutch rule in Taiwan.

1684 Manchus replace the Jheng family as the new rulers of Taiwan.1895 The Treaty of Shimonoseki concludes Sino-Japanese War; Taiwan is

ceded to Japan.

1945 Taiwan is retroceded to China after 50 years of Japanese occupation.

1949 The central government of the Republic of China relocates to Taiwan, after the mainland falls to the Communists.

1947 Due to bad administration, ethnic tension, and other factors, an

islandwide uprising, known as the February 28 Incident, breaks out.

1996 The first direct presidential election is held.

2000 Democratic Progressive Party candidate Chen Shui-bian is elected president of the Republic of China, ending the KMT's 50-year hold on the presidency in Taiwan.

Chronology

Senior Citizen’s Welfare Law established in 1980 and then amended in 1997.

• The Constitution

Social security should include employment policy, social insurance, social relief, medical services, national health insurance, and women, disabled, and aboriginal Taiwanese welfare policies.

• Intensive Elderly Care Service Project 1998

provide various services for older people in the communities, including homecare service, day-care centers, medical services, and elderly residential plans.

Welfare Policies

• Guidelines and Action Plans for Service Industry Development Medical, health care & care-giving services 2004

Care services: Inpatient care, home care, community day care centers, Alzheimer's patient centers, etc. Senior citizens’ housing: Housing for the elderly and other related industries, including transportation, tourism, trusts, entertainment, and insurance.

Increasing Old Age in Taiwan

1.47 2.043.54

5.177.1

8.93

14.08

20.07

0

5

10

15

20

25

1993 2001 2020 2031

year

Old age(over 65)population (million)

Percentage in allpopulation (%)

(Ministry of Interior of Taiwan, 2003)

Changes of old age over 65 in Asian countries

6.87.4

7.9 8.3 8.6 8.8

14.115.1

16.2

17.318

5.4 5.7 6.16.6

7.2 7.6

5.9 6.1 6.4 6.6 6.8 7

5.7 66.9

7.46.8 7.1

13.1

0

2

4

6

8

10

12

14

16

18

20

1992 1994 1996 1998 2000 2001

Year

%

Taiwan

Japan

South Korean

Singapore

China

(Ministry of Interior of Taiwan, 2003)

Changes of old age over 65 in six countries

2.64.2

7.5 8.4

16.6

6.39.1

14.517.2

27.4

12.515.6 15.2 16

22.9

12.114 14.9 15.7

21.3

9.511.3 12.6 12.4

18.1

0

5

10

15

20

25

30

1965 1980 1995 2000 2025

year

perc

ent (%

)

Taiwan

Japan

Germany

France

UK

USA

(Da-Ho Liu,2001)

Old age population dependency ration/working and retired population ration in six countries

Country 1995 2025

Age(%) Old age population dependency Ration (%)

Working population: Retired population (%)

Age(%) Old age population dependency Ration (%)

Working population: Retired population (%)

20~64 65+ 20~64 65+

Taiwan 59.1 7.5 12.7 7.9:1 63.0 16.5 26.2 3.8:1

Japan 62.7 14.5 23.1 4.3:1 55.4 27.4 49.5 2.0:1

Germany 63.3 15.2 24.0 4.2:1 58.8 22.9 38.9 2.6:1

France 59.0 14.9 25.3 4.0:1 56.4 21.3 37.8 2.6:1

UK 58.8 15.5 26.4 3.8:1 52.5 19.0 36.2 2.8:1

USA 58.1 12.6 21.7 4.6:1 54.8 18.1 33.0 3.0:1

Current Community Care Services

A. Homecare Service B. Day Care Service

1. Housework Service Cooking, laundry, cleaning, grocery shopping

C. Continue Education

Programs

2. Paperwork Service

Apply welfare services, pay bill, write letters for

clients, help them read books or news.

D. Recreation Centers

3. Medical Service Accompany older people to see a doctor, help

them take medicine and take simple exercise

E. Hotline Service

4. Emotional Support Service Talk to older people, emotional support, care

about their health and lives, phone service

F. Meal on Wheels Service

5. Leisure Service Accompany older people to visit friends, attend

activities, go for a walk.

H. Physical Examination

Home Care Service

Day Care Service

Elderly Volunteer Service

Elderly Continue Education Program

year

Number of clients

Number of service times

(counted by the service

item from 2000)

Number of older

people (includes temporary care from

2000)

Number of service times

(counted by the day from 2000)

Number of

Teams

Number of

Volunteer

Number of

Education Centers

Number of the

programs

Number of Older

People Enrollment

1996 ... 165,297 ... 197,086 58 2,495 302 1,849 60,320

1997 ... 193,221 ... 256,132 47 2,564 220 1,995 74,976

1998 ... 294,645 ... 314,358 76 3,897 255 2,068 77,886

1999 7,064 580,870 974 176,659 91 3,666 241 2,364 79,807

2000 8,194 699,724 1,375 215,393 164 5,779 303 2,818 93,244

Elderly Welfare Service in Taiwan (1996~2000)

Elderly Protection Elderly Welfare Services Center

Elderly Community

Clubs Hotlines Abandoned Abused Neglected

year

Number of the Clients

Number of times

Number of Clients

Number of Clients

Number of

Hotlines

Number of Times

Number of Old

People

Number of times

(Services)

Number of Old

People

Number of times

(Services)

Number of Old People

Number of Times

(Services)

1996 213 ... 3,442 ... 24 5,994 ... ... ... ... ... ...

1997 246 ... 3,480 ... 152 6,923 ... ... ... ... ... ...

1998 249 ... 3,893 ... 45 33,785 ... ... ... ... ... ...

1999 258 2,803,487 3,940 1,645,211 167 9,452 140 1,119 260 1,190 649 2,602

2000 259 2,625,955 3,899 1,736,429 65 27,857 121 1,446 190 744 393 1,603

Elderly Welfare Service in Taiwan (1996~2000)

Meal Services

Number of Older People Receiving Elderly Housing Improvement

Year Number of Older People

Number of Times (Services)

1996 ... 118,128 800

1997 ... 195,753 760

1998 ... 33,593 767

1999 5,419 802,825 493

2000 9,360 1,351,431 1,124

Elderly Welfare Service in Taiwan (1996~2000)

(Ministry of Interior, 2003)

Lack of the quality management of social services

Current Problems

Lack of a welfare resource system support families

with elderly members

Fragmented community care services

Administration problems

Lack of a welfare resource system support families with elderly members

Decrease the intention to take care of elderly members

Difficulties in accessing welfare resources

Welfare resources are centralized in the urban areas

Administration problems

Five categories of institutions:

Elderly accommodation institution-Ministry of Health

Nursing home

Elderly community shelter Ministry of Interior

Elderly continuing education programs

Social service agencies

Fragmented community care services

Social services overlap in some areas.

Some communities do not have enough resources to provide social services.

A lack of communication among different professional workers.

Lack of the quality management of social services

Some private welfare agencies provide services based on the spirit of charity.

Three hundred and twenty-eight nursing home are still running illegally.

Lack of a standard assessment and a monitoring system.

Research AimResearch AimEstablish an integrated community Establish an integrated community care model to improve these care model to improve these problems. problems. Research Questions

The outcome of an integrated community care service model

How does an integrated service model meet the needs of older people and solve current problems?

Lack of coordination

Does a lack of coordination among service providers cause duplication,oversupply, or insufficient services for older people?

An integrated community care service model

What are the essential resources for establishing an integrated community care services for older people?

Quality control of community care service How can the quality of services which provided by multiprofessional teamwork be evaluated?

Four locations, including both rural and urban areas, were chosen by the level of urbanization and their locations in Taiwan.

(1) Wan-Han Elderly Service Centre

in Taipei city,

(2) Ann-Ping Elderly Service Centre

in Tainan city,

(3) Mennonite Social Welfare

Foundation in Hualien county,

(4) Home Care Support Centre in

Changhua county.

Sampling

Area Taipei City Chung-Hwa County

Hau-Lien County Tainan City

Agency Wan-Hua ElderlyService Centre

Chunghwa Christian Hospital

Mennonite Social Welfare Foundation YMCA Ann-Ping Elderly Service Centre

Interview

1. Homecare support and long- term team:

1 director2 social workers1 homecare supervisor

(social worker)1 homecarer1 nurse1 carer

 

1. Homecare support team:1 director (nurse)2 homecare supervisors (nurse)1 social worker1 government administer1 elderly people2 homecarers

1. Homecare support team:1 social worker1 homecare supervisor (nurse)1 director2. Meals on wheels service team: 1 social worker 1 dietician 1 driver 3. Emergency notifying service team:1 social worker1 nurse1 director

1. Homecare support team:

1 social worker2 homecarers/ supervisors1 elderly people 2. Day care team:1 social worker1 director1 military service person1 elderly people

 

Homevisit

Once 13 times One day: 20 old people Once homevisitOnce hospital visit

Meeting

None Twice 1. Team meeting2. Governmental meeting

3 times 1.Team meeting2.Meals on wheels team meeting3.Meeting for social worker licence exam

Once: Team meeting

  

Data Collection

Social Worker Homevisit

Clarify service

area and process

Case referralVolunteers support

Homecare service

supervision

Assess applicants for

homecare service

Homecare Service Support

Center

Department of Community Health

Department of Social Work

Hospital

Local Government

Head of Neighborhoods

Social Work Association

Welfare Agencies

Other Homecare Service Support

Centers

Administration Division

Case ReferralHomecare SupervisionCase referral

Palliative Care Ward

Discharge Planning Committee

Ward station

Long-term Care Center

Case referral

Service promotionCase referral

Case referral

Homecare Support Service Centre in Hospital

Findings

Welfare Foundation

Emergency supportCase referral

Meal provider

Case referral

Meals on wheels Service

Homecare service

Emergency notifying service

Case workersPrivate Hospital (related to the Foundation)

Administration Division

Local Government

Police Office

Long-Term Care Center

IT Company

Head of Neighborhoods

Case referral/ Financial supportResource sharing

Case referralResource sharing Annual/

monthly report

Technique support

Meal delivery

Social workers refer cases/resource connectionOT/PT for clients with stoke

Public Health Center

Private Welfare Agency

Social Welfare Foundation in Hwalien

Doctor

Nurse

Dietician OT

Homecarer

Social

worker

Clerk

Homecare supervisor

Older People

Social

Worker

Psychological aspect

Living condition

Financial resource

Resource utilization

Pay more respect

HomecarerCaring skills

Living condition

Homecare Supervisor

Homecare services

Emotional part

Physical condition

Diseases

Medicine taking

Harsh on clients

Nurse

Medical care

Dominate the professionsDoctor

Nutrition care

Meal plan

Paper work

Service calculation

Reception

Dietician

Clerk

Coordination

Joint meetings

Understanding the roles of each profession

Commitment on working together

Clarify duty of each position

ResourcesGovernment support/Donation/Clients pay for services

Advantage of public agency and religious welfare agency

Informal supports

Volunteers

resource connection system

1.

Quality control

Outcome evaluation

unification of assessment system

Clarify job duties

Continuing training

Integrated Community Care Service

Caring responsibility: formal and informal supports

Medical care service at home

Transportation

Diversity of area, culture, and local resource

Doctor

Nurse

Dietician

OT

Home-

carer

Homecare supervisor

Clerk

Social worker

Under standing the same level of position, each profession respects each other and works together.

Learning professional knowledge from each other will enhance communication and increase resources sharing.

Administration & Supervision of services

Health Supports

Welfare service Supports

Informal care supports

Head of neighbourhood/Administration Division

Hospitals

Public Health Centre

Welfare agenciesVolunteers

Police office

Religion Groups

Fire Bureau

Older people

Long-term Care Centre

Families & relatives

Neighbourhoods

Local/Central Government

Dep. of Health/

Central Government

Local/Central Government

Local/ Centre

Government

Transportation

Older people receiving

homecare service in

Chung-Hwa county